Srp Ark Celok Lek
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The most common fracture involving the wrist is a fracture of the scaphoid bone [1], and only 5% to 10% of these fractures proceed to nonunion. Although not symptomatic initially, most (if not all) nonunions later produce a painful wrist with impaired function, clinically significant loss of motion, increased weakness and degenerative arthritis. Nonunion of the scaphoid bone should be treated by open reduction and internal fixation. Many surgical procedures have been advocated to achieve union. Most widely used technique for the treatment of scaphoid nonunion was described by Russe [2], but this method may overcome the flexion deformity of the scaphoid and carpal deformities. The ununited scaphoid usually undergoes resorption of the fractures surfaces, principally over the anterolateral aspect of the fracture, so that the scaphoid becomes misshapen. The restoration of the exact length and form is enabled by insertion of a tight-fitting trapezoidal corticocancellous graft, a technique described by Fernandez [11]. ⋯ In our series, both procedures provided a high union rate [2]. In cases with severe scaphoid shortening and flexion deformity, Russe's procedure has proved to be insufficient to restore anatomic length and correction of carpal alignment [6, 11, 17]. Previous authors have reported that the progression in degenerative changes was slower in patients who had a lateral interscaphoid angle less than 45 degrees [13]. Also, grip strength and range of motion increased in patients in whom flexion deformity of the scaphoid had been corrected [2, 4, 6, 16, 17]. Our study supports these findings, except results regarding the movement. We believe that this was due to postoperative scarring. Discrepancy between the subjective and objective results may have been due to postoperative relief of pain obtained by increased carpal stability or decreased range of motion of the carpal joints due to postoperative scarring. If pain is relieved, patients readily adapt to the functional deficit of decreased range of motion. We concluded that angulatory collapse of the scaphoid resulted in nonunion as well as malunion with secondary functional loss. Recognition and avoidance in acute fractures were important. When recognised late, volar wedge grafting appeared to be a satisfactory method of treatment.
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[Relation between gene mutations and pancreatic exocrine function in patients with cystic fibrosis].
Cystic fibrosis (CF), is the most common autosomal-recessive disease in Caucasians, with an incidence of approximately 1:2500 live births and a carrier frequency of approximately 4-5%. Causes of the disease are mutations in the CF gene which is located on chromosome 7 (region 7q31). Although a single mutation, a deletion of phenylalanine at position 508 (DF508) in exon 10, accounts for almost 70% of all CF chromosomes, over 900 other mutations have been identified in this large gene. ⋯ This study strengthens the hypothesis that pancreatic function status in CF is genetically determined by specific mutations at the CF locus. Our data also strongly support the hypothesis that, with respect to pancreatic function, "mild" mutant alleles confer a higher residual CFTR activity than do "severe" mutant alleles. Although PS occurs in patients who have one or two "mild" mutations, PI occurs in patients who are homozygous or who are genetic compounds of two "severe" mutant alleles.
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Neonatal septicaemia is characterized by high mortality so that intravenous antibiotics must be administered on clinical suspicion. Initial antibiotic therapy, before the results of microbiological evaluation, is based on empirical data in regard to sensitivity of prevalent bacterial strains. In the past years, aetiological causes of neonatal sepsis have been changed with an increased bacterial resistance to the usual combination of initial antibiotics. ⋯ Measurement of serum CRP concentration is useful for diagnosis of severe neonatal sepsis. In our study all isolated bacterial strains were comparable in their ability to activate systemic inflammatory response and CRP production. It is known that serial CRP measurements during neonatal sepsis are useful in making decision to cease antibiotic treatment. The highest serum CRP concentrations were detected during the first day of illness but, in some cases even with appropriate treatment, CRP peak levels due to sustained pro-inflammatory action of interleukin-6 production could be detected even 24 hours after treatment was started. Our study showed that in patients with non-adequate initial antibiotic therapy of neonatal sepsis serum CRP concentrations increase further during the second day of treatment. By contrast, the use of appropriate antibiotic therapy in the same time period followed the significant decrease of serum CRP levels in our patients. Therefore, increase of CRP level during initial treatment, especially during the second day of treatment of neonatal sepsis should be taken as indication for replacement of initial antibiotics, even before sensitivity of microbiological causes to given antibiotics is known.
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The increase of sexual activity among the adolescents has become a danger to their reproductive health. The goal of this study was to explore sexual behaviour of young people, to establish risks that endanger their reproductive health, and to find out the ways to reduce the consequences of adolescent sexuality. The study was conducted in the Mother and Child Health Care Institute of Serbia over a 2-year period. ⋯ In order to increase the number of adolescents who will use a condom, the following measures are necessary: a better quality of condoms (54.0%), installation of condom machines (15.6%), mass media education programmes on the significance of the condom role in the prevention of sexually transmitted diseases (10.0%), attractive design of condoms (7.0%), free condoms (6.7%), and universal accessibility of condoms (1.0%). The reproductive health of adolescent girls in Belgrade has been endangered by: their sexual behaviour, poor acceptance of healthy life styles, lack of responsibility in sexual relationships and high prevalence rates of unintended pregnancy and sexually transmitted diseases. Improvement of adolescent reproductive health could be achieved by: educational programmes for adolescents about sexuality, reproduction and contraception; appropriate adolescent advisory health care services; and a better condom quality.
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In most prospective, randomized studies, severely depressed left ventricular function is found to be the independent predictor of increased morbidity and mortality after myocardial revascularization [3]. Surgical treatment in this particular group of patients results in superior long-term results [1, 2]. Internal thoracic artery (ITA) is considered to be superior compared to venous grafts in myocardial revascularization for the majority of patients with ischaemic heart disease. However, its value in patients with already severely depressed left ventricular function (EF < or = 30%) is still a matter of debate. There are no prospective, randomized studies, so far. In some studies it was shown that revascularization with ITA graft resulted in superior long-term results (10- and 15-year follow-up) in all subgroups of patients, including those with severely depressed left ventricular function [4, 5]. Some authors find it still unacceptable, if this result would be possible at the expense of higher early mortality (due to use of ITA). The purpose of this study is to analyze the early and long-term results of myocardial revascularization using ITA graft in patients with severely depressed left ventricular function (EF < 30%). ⋯ ITA graft is a very good and absolutely acceptable choice in patients with severely damaged left ventricular function, particularly if we consider its long-term superiority. These pts should not be deprived of the long-term benefit of ITA graft, since early results are very good.